ICYMI: Spyros Panos averaged 17 surgeries per day

Lawyers ask why hospitals didn't take action earlier

Jul. 22, 2013

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Poughkeepsie Journal

Dr. Spyros Panos

A view of the campus at Vassar Brothers Medical Center in the City of Poughkeepsie. Records show Dr. Spyros Panos did 69 surgeries over four days, or an average of 17 per day, at the center. / Darryl Bautista/Poughkeepsie Journal

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Surgical records of a former local orthopedic surgeon show he performed half as many operations in one day as the typical orthopedic surgeon averages in one month raising questions about administrative oversight and patient safety.

Dr. Spyros Panos was in nearly back-to-back surgeries over the course of sometimes 12-hour-long surgery days, often with two patients under anesthesia at the same time, according to records kept by the City of Poughkeepsie hospital where he had privileges. In three cases, he was in two surgeries at the same time, according to the records. He frequently performed short operations — one was only seven minutes — according to his surgical schedules at Vassar Brothers Medical Center. The logs are for four days between Dec. 31, 2009, and Dec. 16, 2010.

The records, obtained by the Poughkeepsie Journal, show the times of surgeries and administering of anesthesia but don’t contain a description of the procedures or names of patients.

Former Panos patients, in multiple medical malpractice lawsuits, allege the hospitals where their surgeries occurred failed to notice, limit and question the quantity of surgeries Panos was booking in a day. They said in court documents that Mid Hudson Medical Group failed to question the high volume of patients seen on his office days or the spike in his billing, and ignored warnings from its employees regarding his surgical practices.

Panos was an orthopedic surgeon at Mid Hudson Medical from 1999 until July 2011, when he was fired, according to the group. In the 261 lawsuits filed against him since January 2009, he is accused of botching surgeries, doing unnecessary surgeries on healthy patients, or faking surgeries and prolonging patients’ ailments, according to court documents.

Plaintiffs’ attorneys JT Wisell of Queens and Brian Brown of Manhattan allege Panos couldn’t have done legitimate surgeries during the times given on the surgical records involving their clients, which list multiple procedures performed under eight minutes. And an orthopedic surgeon in Philadelphia said he couldn’t “imagine” how Panos managed to do that many surgeries in a day.

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However, with an efficient surgical team and minor operations, such as a steroid shot for back pain, it’s possible to have a high volume of cases in one day, said Marsha Wallander, associate director of the Accreditation Association for Ambulatory Health Care. The association measures the quality of ambulatory surgical centers’ care, including at theHudson Valley Center at Saint Francis Hospital, where Panos had privileges. The center closed in May.

It’s not unusual to have one patient being brought to the recovery room while that operation room is readied for the next one, she said, adding, “It’s a very well-orchestrated dance number.”

But even Wallander acknowledged that 20 surgeries in one day “seems like a largenumber.”

The lawsuits against Panos are pending in state Supreme Court in Dutchess County. Many of the lawsuits also name Panos’ surgical assistant, Robert Morgantini, Mid Hudson Medical, Vassar Brothers, Saint Francis and the Hudson Valley Center.

Panos didn’t respond to Journal messages and has declined to comment previously. So has his law firm, Feldman, Kleidman & Coffey. Morgantini didn’t return Journal messages left at his Hopewell Junction office.

Mid Hudson Medical, Saint Francis and Vassar Brothers declined to comment on pending litigation, through representatives or their attorneys.

Too many surgeries?

The Journal obtained Panos’ surgical records for Dec. 12, 2009, May 20, 2010, July 29, 2010, and Dec. 16, 2010. These were the only records available to the Journal. Operation times are tracked by the start and end of anesthesia.

According to a Journal analysis, the logs show:

• For those four days, Panos did 69 surgeries, or an average of 17 per day.

• In three cases, Panos was supposedly in surgery with two different patients at the same time: On Dec. 16, 2010, Panos was supposedly in surgery with one patient from 9:15 a.m. to 10:25 a.m. and with another patient from 9:57 a.m. to 10:27 a.m. On the same day, he supposedly finished a surgery at 2:40 p.m. but had started another surgery at 2:28 p.m. that also ended at 2:40 p.m.

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• Panos’ highest-volume day was 19 surgeries in 10 1/2 hours. His volume of surgeries ranged from 10 in 6 1/2 hours to 20 in 12 hours.

Plaintiffs’ attorney Brown said he has seen a dozen Vassar Brothers surgical logs for days ranging from April 24, 2008, to Dec. 16, 2010, which show the same pattern — Panos did between 15 and 22 surgeries each day. He is still analyzing Saint Francis’ surgical logs involving Panos.

Wisell, who represents 152 plaintiffs, said Panos jumped from operating room to operating room, even leaving a patient on the table to begin another procedure.

“It’s bizarre,” he said.

The average orthopedist in the country performs 32 procedures per month, according to a 2012 survey by the American Academy of Orthopaedic Surgeons. Panos most likely exceeded that average in the course of a week, Wisell said.

An orthopedist who works for a medical group that offers several specialties does an average of 34 per month, versus 36 per month for an orthopedic group-employed physician or 31 per month of hospital-employed physicians, the survey found. Orthopedists in the mid-Atlantic states average 30 to 35 procedures per month.

“It’s not possible,” Westchester County attorney Stephen Haber said about Panos’ volume of surgeries. The attorney has five clients suing Panos.

“You don’t want to be hustling with someone’s knee. You want to be methodical,” said Dr. John McPhilemy, an orthopedic surgeon in Philadelphia in private practice and team doctor to the NBA’s Philadelphia 76ers. He also leads a residency program for the Philadelphia College of Osteopathic Medicine’s orthopedic surgery department.

He has no ties to the Panos cases.

In one day, McPhilemy, 66, does about six to seven minor surgeries, such as a minimally invasive arthroscopic procedure to make repairs to joints. Or he might do five minor surgeries and one complex case, such as a total knee or hip replacement.

A 'typical' day

McPhilemy typically meets with a patient in the surgical holding area just before the operation to verify he or she hasn’t eaten and has no new health risks. The surgeon goes over the procedure, marks the surgical site and calms any jitters.

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“That’s usually a five-minute deal,” he said. He accompanies his patient into the operating room, and disinfects his hands and arms, or scrubs in for the surgery, while the patient is prepped and covered with a sterile barrier. He is there when the patient is given anesthesia and immediately after, when the surgical team takes a “timeout” to verify the person’s identity, type of surgery, site of the procedure, medical history, etc.

After he performs surgery, McPhilemy closes the incisions, bandages the wound and stays with his patient. He said, “Usually you are there until the patient leaves the room. You leave with them.”

He labels any surgical pictures he’s taken, including a set for his patient, writes prescriptions and dictates notes about the operation. He meets with any family members and describes what he found, what he did and shows them the pictures.

Then he might meet with his next patient.

“In my mind, it’s difficult to imagine doing 20 surgeries in a day,” he said. “Who is talking to the family of the patients after you operated on them? Who is saying, ‘Everything’s fine. This is what we did. Here are pictures to understand it. Here are his prescriptions.’ I don’t know how this guy did it.”

After three surgeries by Panos at the Hudson Valley Center at Saint Francis, including two knee repairs, City of Poughkeepsie resident Chris Hanson never got better. At age 55, he can’t work and he has trouble walking.

He said Panos spent “two minutes tops” talking to him before his operations. After his surgeries, he never saw or talked to Panos. He spoke only to a nurse, who didn’t offer information about the success of his surgeries.

Last year, Hanson filed a lawsuit against Panos because he says he never got better after the surgeries. He claims the doctor didn’t actually operate on his knees and made him worse by improperly operating on his big toe.

A surgeon who does 20 surgeries in a day is either trying to be efficient with his time or, “worst case, you don’t give a damn and you are trying to make money,” McPhilemy said.

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Hanson gave the Journal a medical invoice showing that the Hudson Valley Center filled a claim with Medicare for $13,389 for his Feb. 16, 2010, arthroscopic knee surgery.

“It is infuriating,” Hanson said. “This guy took advantage of me.”

Another lawsuit involves a Poughkeepsie teenager whose left knee ached and popped and who did not get better after Panos operated in 2008, according to court documents filed by the law firm Basch & Keegan of Kingston. Panos said he could fix Sarah Hicks’ knee, attempted to do so “and in fact, did nothing,” her attorney alleged in the lawsuit.

A comparison of pre- and post-operation X-rays shows Panos did nothing to her knee, according to her suit. In 2011, Hicks had another operation under the care of a different surgeon. That procedure provided pain relief, the suit said.

Panos’ surgical logs are a defense attorney’s “nightmare,” said Michael S. Kelton, a New York City-based medical malpractice defense attorney for physicians and insurance carriers, who has no ties to the Panos cases.

“It certainly calls into question whether or not the procedures were done in the first place,” he said, “and whether or not they were done appropriately, with the level of care and attention one would want from their orthopedic surgeon.”

Hospital oversight

Hospitals use a panel of physicians to review surgical cases that may raise red flags, said Kevin Dahill, president and CEO for the Northern Metropolitan Hospital Association, a trade group that includes mid-Hudson hospitals.

Typically, a hospital’s head of surgery is in charge of doctors with surgical privileges, Dahill said. The surgery head is part of a physician-peer-review process, where, if a question arose about the quality or frequency of a surgeon’s work, a doctor could be asked to justify his technique and judgment calls. The physician’s competence and professional conduct are probed.

“Very often, the chair of surgery, based on peer review, can determine what’s a reasonable length of time for a procedure and what’s a reasonable length of time a surgeon should spend in total. It wouldn’t be unprecedented for a chairman to say cases are too short or too long, or to restrict surgeons,” Dahill said.

Plaintiffs’ attorney Haber questioned how much the hospitals knew about “what he was doing.”

McPhilemy said, “I can’t imagine scheduling 20 surgeries without someone coming to me saying, ‘Can you do this? What kinds of surgeries are these that you can do them this far apart?’ ”

Brown said the surgical logs are “irrefutable evidence” that others knew Panos was putting people under anesthesia and, in some cases, doing nothing at all, and billing for multiple procedures.

“There will be another Panos someday,” he said. “The question is: Will the hospitals or his colleagues put a stop to it before hundreds of people are injured?”